Breast Cancer Research and Treatment

, Volume 128, Issue 3, pp 749–753 | Cite as

Occult breast carcinoma in breast reduction specimens in European women

  • Amit Goyal
  • Samuel G. Coulson
  • Jessie M. Wu
  • Simon Kim Suvarna
  • Malcolm W. R. Reed
  • Christopher M. Caddy
Clinical Trial


Breast reduction is a common surgical procedure performed by plastic and oncoplastic breast surgeons. The authors report on the incidence and management of cancer and atypical hyperplasia in breast reduction specimens from one institution over a 10-year period. All patients who underwent breast reduction surgery at Northern General Hospital, Sheffield were identified from an electronic prospective database. The histopathology reports were analyzed. Case records of all patients with significant abnormalities were retrieved and examined to identify their management and follow-up. Between October 1999 and April 2010, 1,588 patients underwent breast reduction. Nine specimens showed atypical hyperplasia (0.57%). Five cancers were detected (0.31%). Four of the five patients had normal screening mammograms 1–3 years before the reduction operation. Of these cancers, four were invasive (three lobular, one ductal) (0.25%) and one was DCIS (0.06%). A lump was felt macroscopically by the pathologist in two of the four patients with invasive cancer. The patients with DCIS did not undergo further surgery, whereas those with invasive disease underwent mastectomy (three patients) and axillary nodal staging (four patients). None of the patients with normal post-reduction breast imaging had residual cancer on histology. The incidence of occult carcinoma in breast reduction specimens is low. Patients should be counseled with regards to the possible consequences preoperatively.


Breast cancer Breast reduction Mammography Reduction mammoplasty Screening 


Conflict of interest



  1. 1.
    O’Blenes CA, Delbridge CL, Miller BJ, Pantelis A, Morris SF (2006) Prospective study of outcomes after reduction mammaplasty: long-term follow-up. Plast Reconstr Surg 117:351–358PubMedCrossRefGoogle Scholar
  2. 2.
    The Royal College of Pathologists (2005) Histopathology and cytopathology of limited or no clinical value, 2nd edn. Accessed 20 April
  3. 3.
    Jansen DA, Murphy M, Kind GM, Sands K (1998) Breast cancer in reduction mammoplasty: case reports and a survey of plastic surgeons. Plast Reconstr Surg 101:361–364PubMedCrossRefGoogle Scholar
  4. 4.
    Snyderman RK, Lizardo JG (1960) Statistical study of malignancies found before, during, or after routine breast plastic operations. Plast Reconstr Surg Transplant Bull 25:253–256PubMedCrossRefGoogle Scholar
  5. 5.
    Tang CL et al (1999) Breast cancer found at the time of breast reduction. Plast Reconstr Surg 103:1682–1686PubMedCrossRefGoogle Scholar
  6. 6.
    Colwell AS, Kukreja J, Breuing KH, Lester S, Orgill DP (2004) Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg 113:1984–1988PubMedCrossRefGoogle Scholar
  7. 7.
    Cook IS, Fuller CE (2004) Does histopathological examination of breast reduction specimens affect patient management and clinical follow up? J Clin Pathol 57:286–289PubMedCrossRefGoogle Scholar
  8. 8.
    Kakagia D, Fragia K, Grekou A, Tsoutsos D (2005) Reduction mammaplasty specimens and occult breast carcinomas. Eur J Surg Oncol 31:19–21PubMedCrossRefGoogle Scholar
  9. 9.
    Clark CJ, Whang S, Paige KT (2009) Incidence of precancerous lesions in breast reduction tissue: a pathologic review of 562 consecutive patients. Plast Reconstr Surg 124:1033–1039PubMedCrossRefGoogle Scholar
  10. 10.
    Familial breast cancer: the classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care (partial update of CG14). Accessed 20 April
  11. 11.
    Breast cancer (early & locally advanced): diagnosis and treatment. Accessed 20 April
  12. 12.
    Ambaye AB et al (2009) Carcinoma and atypical hyperplasia in reduction mammaplasty: increased sampling leads to increased detection. A prospective study. Plast Reconstr Surg 124:1386–1392PubMedCrossRefGoogle Scholar
  13. 13.
    Vaittinen P, Hemminki K (2000) Risk factors and age-incidence relationships for contralateral breast cancer. Int J Cancer 88:998–1002PubMedCrossRefGoogle Scholar
  14. 14.
    Chen Y, Thompson W, Semenciw R, Mao Y (1999) Epidemiology of contralateral breast cancer. Cancer Epidemiol Biomarkers Prev 8:855–861PubMedGoogle Scholar
  15. 15.
    Hennedige AA, Kong TY, Gandhi A (2009) Oncological screening for bilateral breast reduction: a survey of practice variations in UK breast and plastics surgeons. J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2010.12.001
  16. 16.
    Selber JC et al (2009) Breast cancer screening prior to cosmetic breast surgery: ASPS members’ Adherence to American Cancer Society Guidelines. Plast Reconstr Surg 124:1375–1385PubMedCrossRefGoogle Scholar
  17. 17.
    Campbell MJ, Clark CJ, Paige KT (2010) The role of preoperative mammography in women considering reduction mammoplasty: a single institution review of 207 patients. Am J Surg 199:636–640PubMedCrossRefGoogle Scholar
  18. 18.
    Slezak S, Bluebond-Langner R (2011) Occult carcinoma in 866 reduction mammaplasties: preserving the choice of lumpectomy. Plast Reconstr Surg 127:525–530PubMedCrossRefGoogle Scholar
  19. 19.
    Kiluk JV et al (2010) Effects of prior augmentation and reduction mammoplasty to sentinel node lymphatic mapping in breast cancer. Breast J 16:598–602PubMedCrossRefGoogle Scholar
  20. 20.
    Rodriguez FJ et al (2009) Sentinel node biopsy in patients with previous breast aesthetic surgery. Ann Surg Oncol 16:989–992CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Amit Goyal
    • 1
  • Samuel G. Coulson
    • 2
  • Jessie M. Wu
    • 2
  • Simon Kim Suvarna
    • 3
  • Malcolm W. R. Reed
    • 4
  • Christopher M. Caddy
    • 2
  1. 1.Department of SurgeryRoyal Derby HospitalDerbyUnited Kingdom
  2. 2.Department of Plastic SurgerySheffield Teaching HospitalsSheffieldUnited Kingdom
  3. 3.Department of HistopathologySheffield Teaching HospitalsSheffieldUnited Kingdom
  4. 4.Department of OncologyUniversity of SheffieldSheffieldUnited Kingdom

Personalised recommendations